Understanding The Diagnosis Of Diabetes Nursing Essay
This case study will describe the care of a patient newly diagnosed with Latent autoimmune diabetes of adulthood (LADA). It will demonstrate the author’s understanding of diabetes and its complications, and highlight the importance of providing high quality information to empower the patient to manage the disease.
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Get Help Now!The Nursing and Midwifery Council’s guidelines will be adhered to by using pseudonyms to protect patient confidentiality and the patient will be known as Mr James Smith.
In the United Kingdom there are currently over two and a half million people with diabetes mellitus, and up to half a million people with the condition who don’t know they have it. It is estimated that including both adults and children, fifteen per cent of these figures are patients suffering from Type 1 diabetes and eighty five per cent are patients suffering from Type 2 diabetes (Diabetes.co.uk, 2009).
The World Health Organisation in 1999 defined diabetes mellitus as “a metabolic disorder of multiple aetiology characterised by chronic hyperglycaemia with disturbances of carbohydrate, protein and fat metabolism resulting from defects in insulin secretion, insulin action, or both” (Sign, 2001, p. 2)……..
In our bodies, fuel and oxygen are vital for cells to stay viable. Glucose is our major fuel and comes from the food we eat. Levels of blood glucose concentration are monitored by beta cells found in the islet of langerhans located in the pancreas. These cells secrete the hormone insulin when glucose levels are high and less insulin when glucose levels lower. When the beta cells do not function properly, and the blood glucose concentration rises, this is known as diabetes (Matthews et al, 2008, p. 3).
Diabetes mellitus is generally categorized into Type 1 and Type 2 (Matthews et al, 2008, p. 1). Type 1 diabetes is a result of an autoimmune destruction of the beta cells of the islets of langerhans in the pancreas (Hitman, 2001, p. 10). Typically, people with Type 1 diabetes are usually under 40 years of age, of slim build, ketosis-prone, islet cell antibody and/or glutamic acid decarboxylase autoantibodies (antiGAD-Ab) positive, experience a rapid onset of symptoms and are unable to survive without insulin treatment (Hillson, 2008, p. 14).
The commonest form of the disease is Type 2 diabetes and can be characterized by the disorders of insulin resistance and insulin secretion (Zimmet et al, 2004, p. 9).
The risk of developing Type 2 diabetes escalates with obesity, physical inactivity, and age. These factors are attributing to the rising number of people being diagnosed with the disease, ultimately causing an explosion in the prevalence of Type 2 diabetes (McGuire and Rao, 2007).
Meetoo (2004, p. 646) suggests that a diagnosis of diabetes will instantly increase the persons’ risk of developing microvascular and macrovascular complications.
Early prevention of these complications are key to ensuring people live long healthy lives (Hillson, 2008, p. 270).
Rationale
The author of this case study works as a diabetes specialist nurse/research nurse in a local district general hospital where she first met Mr James Smith. The gentleman is forty six years old, lives with his wife and reports to have good health. He is not treated with any medication, is a non-smoker and limits his weekly intake of alcohol to eighteen units.
Mr Smith attended an outpatient appointment after he was referred by his General Practitioner to the consultant diabetologist and his team for specialist advice with a six week history of polyuria, polydipsia and weight loss. Rubin and Jarvis (2007, p. 23) suggest that frequent urination, thirst, fatigue, and weight loss can be early symptoms of diabetes mellitus.
The gentleman was diagnosed with a form of diabetes known as latent autoimmune diabetes of adulthood (LADA). This is a slowly progressive form of Type 1 diabetes in which there is autoimmune destruction of the beta cells in the pancreas (Deutekom, Heine, and Simsek, 2007).
The author’s interest in latent autoimmune diabetes of adulthood stems from the fact that many people with this type of diabetes are often misdiagnosed with Type 2 diabetes. Latent autoimmune diabetes of adulthood has an insidious onset of hyperglycaemia comparable to that of Type 2 diabetes (Appel et al, 2009, p. 156).
Making the correct diagnosis of latent autoimmune diabetes of adulthood is imperative as patients will usually have an absolute insulin deficiency within an average of two to six years, and will require initiation of insulin therapy (Davies et al, 2008, p. 1354).
Correctly diagnosing Mr Smith was especially important due to his occupation as a train driver. Hillson (2008, p. 432) suggests that people treated with oral hypoglycaemic drugs may be allowed to drive trains if they can prove their diabetes is well controlled and they have no tissue damage which may impair functions necessary for the role. However, people treated with insulin are not permitted to be in control of trains because of the greater risk of hypoglycaemia.
Assessment
In the local area, patients diagnosed with Type 2 diabetes over forty five years of age are generally cared for by their General Practitioner. Mr Smith’s General Practitioner recognised tha…………………………
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